Pediatric Surgery: Liquid Perfluorocarbon Ventilation Research Laboratory

Ronald B. Hirschl, M.D.
Professor of Surgery,
Section of Pediatric Surgery
University of Michigan Medical Center

A series of projects related to prevention of lung injury and treatment of ARDS with liquid perfluorocarbon ventilation is being conducted emphasizing the technique of total liquid ventilation. In addition, basic science experiments are being applied in the laboratory as a means for studying the pathophysiology of lung injury and respiratory failure. Finally, development of devices to provide chronic gas exchange support are being developed.

Techniques

  • Liquid ventilation
  • Extracorporeal life support
  • Continuous measurement of O2 consumption and CO2 production
  • Pulmonary function studies
  • Pulmonary capillary filtration coefficient determination
  • Total lung myeloperoxidase assessment
  • 125I Bovine serum albumin capillary leak determination
  • 51Cr labeled red blood cell intraalveolar hemorrhage determination

Equipment

  • Extracorporeal life support equipment
  • Arterial blood gas analyzer
  • Co-oximeter
  • Liquid perfluorocarbon ventilator
  • Continuous O2 consumption and CO2 production analyzer
  • Pulmonary function analyzer
  • Scintillation counter
  • Millar Catheters

Investigator

  • Ronald B. Hirschl, M.D.

Location/Contact

    Kresge I, 7651
    Ronald B. Hirschl, M.D., 764-6846

Total Liquid Ventilation: A Bioengineering Partnership

Collaborators: James Grotberg, M.D., Ph.D.
Funding: NIH

Devices are being developed for oxygenating and warming perfluorocarbon while eliminating carbon dioxide during perfluorocarbon ventilation of the perfluorocarbon-filled lung (total liquid ventilation). The factors related to inflow and drainage of perflurocarbon from the lungs during expiration are being explored to provide the optimal means for performing the technique.

Development of an Implantable Artificial Lung

Collaborators: Robert H. Bartlett, M.D., James Grotberg, M.D., Ph.D.
Funding: NIH

A device which may be implanted and serve as a long-term artificial lung is being developed. Studies on the relationship between pulmonary vascular compliance and right ventricular function and the complex physiology related to replacement of the lungs with such a device are being explored. In addition, the type of hollow fiber and device configuration which optimizes gas exchange is being evaluated. Finally, means for providing CO2 regulation and local anticoagulation are being evaluated.

Studies on the Protective Effects of Perflubron During Liquid Ventilation

Collaborators: James Varani, Ph.D., Kent Johnson, M.D., John Younger, M.D.
Funding: NIH

Previous studies have suggested the presence of a protective effect by perflubron during liquid ventilation in the setting of lung injury and hemorrhagic shock. With these studies, we are further documenting, quantifying, and analyzing the mechanism of the reduction in the inflammatory infiltrate, intraalveolar hemorrhage, and capillary leak previously observed in both acute and chronic models of lung injury. In addition, we are evaluating the in-vitro effect of perflubron upon leukocyte function.

The impact of PEG tubes on the development of gastroesophageal reflux in neurologically-impaired children: a study of their medical, functional and social outcomes.

Collaborators: Robert A. Drongowski
Funding: Research Advisory Committee

PEG tubes have been associated with the development of gastroesophageal reflux. In some pediatric centers, the incidence of GER associated with PEG tubes in neurologically-impaired children is so high that a fundoplication is routinely performed in addition to the PEG tube. While it does appear that some patients do develop GER, the actual incidence of significant GER and its impact on the patients overall outcome has only been estimated by retrospective studies.

The purpose of this study is to prospectively determine the incidence of gastroesophageal reflux resulting from PEG tube placement and to evaluate the medical, functional and social impact of this GER on neurologically impaired.

Finally, a model from this study will be developed that can evaluate the cost and medical impact of various preoperative clinical strategies on the outcome of children receiving PEG tubes.